December 15, 2014

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Summit Call Recap – December 11, 2014

Information from CDC

Announcements

SUMMIT CALL RECAP – DECEMBER 11, 2014

Influenza Surveillance Update – Sophie Smith (CDC)

Sophie provided a summary of the published reports for week 48, ending November 29. Approximately 12.6% of specimens submitted for testing were positive, with a mixture of both A and B. The ILI-Net national data indicated 2.6% of total patient visits were for ILI, which is above the national baseline level of 2.0% for this week. Of the deaths reported through the 122 Cities Mortality Reporting System during week 48, 5.4% were attributed to pneumonia and influenza (P&I), below the 6.5% epidemic threshold for the week. Reports indicated there were 1.8 laboratory-confirmed influenza-associated hospitalizations per 100,000 population.

No new pediatric deaths were reported during the week. A total of 5 pediatric deaths have been reported so far during the 2014–2015 season.

As shown in CDC’s weekly influenza summary map, the geographic spread for influenza for week 48 is:

Widespread – 6 states, Puerto Rico
Regional – 14 states
Local – 19 states, Virgin Islands
Sporadic – 11 states, District of Columbia
No activity – no states
No report – Guam

Since October 1, CDC has antigenically characterized 132 influenza viruses; one 2009 H1N1 virus, 114 influenza A (H3N2) viruses, and 17 influenza B viruses. The 2009 H1N1 virus tested was characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2014–2015 Northern Hemisphere influenza vaccine. Of the 114 influenza A (H3N2) viruses tested, 48 were characterized as A/Texas/50/2012-like, which also is included in this season’s Northern Hemisphere vaccine. Sixty-six viruses tested showed either reduced titers with antiserum produced against A/Texas/50/2012 or belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Among virsues that showed reduced titers with antiserum raised against A/Texas/50/2012, most were antigenically similar to A/Switzerland/9715293/2013, the H3N2 virus selected for the 2015 Southern Hemisphere influenza vaccine. Both B/Victoria and B/Yamagata-lineage viruses are circulating in the U.S. All 10 B/Yamagata-lineage viruses were characterized as B/Massachusetts/2/2012-like, a component of both the trivalent and quadrivalent vaccines for the Northern Hemisphere. All seven B/Victoria viruses were characterized as B/Brisbane/0/2008-like, a component of the 2014–2015 Northern Hemisphere quadrivalent influenza vaccine.

None of the specimens tested this season has shown resistance to oseltamivir or zanamivir.

In response to questions, Sophie reported that CDC’s Weekly Surveillance Report is posted at www.cdc.gov/flu/weekly. A Summit member also asked about anecdotal reports of shortages of antiviral medications in Minnesota and whether this is being seen in other areas. Following the call, Sophie confirmed that no shortages have been reported to the Minnesota Immunization Program. However, she also noted that maldistribution of antivirals can occur in any location. This can be somewhat alleviated by suppliers and pharmacies working to meet the needs in each area.

Other Items – Carolyn Bridges (CDC)

Early Season Flu Vaccination Coverage

Carolyn reported that the surveillance data for early season flu vaccination coverage was posted to the CDC’s FluVaxView website today. The data includes information on children and adults [from the National Immunization Survey (NIS) and the Behavioral Risk Factor Surveillance System (BRFSS), respectively], pregnant women (from internet panel surveys), and health care personnel (also from internet panel surveys). All data indicate we are on track with last year, with coverage of ~40% overall. Coverage for pregnant women was reported at 43.5%. An encouraging note is that increasing numbers of pregnant women (59.5%) report that their health care providers both recommended and offered influenza vaccine. Approximately 64% of health care personnel reported being immunized, which is similar to last year at this time. Health care workers tend to be vaccinated at work, while children are usually vaccinated at a doctor’s office. Adults in the general population are vaccinated at a wide variety of locations, with 33% reporting being vaccinated at a doctor’s office, 25% at a pharmacy, 18.6% at their workplace, and 9% at another medical location. These numbers are similar to prior years. Increases in coverage are anticipated as the season progresses and due to efforts undertaken during National Influenza Vaccination Week. Final end of season data will be reported in September, 2015.

In response to a question about data availability for individual areas, Carolyn noted that the majority of the data is national in scope. However, some state-specific data is available from BRFSS. Information from the 2013–2014 season also is available in FluVaxView.

Holiday Schedule Updates

Summit Calls – Carolyn stated that we do plan to hold our regular Summit call on Thursday, December 18. However calls will not take place on the following two Thursdays (December 25 and January 1).

Surveillance Reports – Sophie reported that the weekly surveillance reports, which usually are posted on Friday of each week, will be delayed until the following Mondays (December 28 and January 5) during the holidays.

INFORMATION FROM CDC

CDC/Influenza Division Weekly Influenza Surveillance Report and CDC Key Points

The CDC weekly influenza surveillance report for week 49 (ending December 6, 2014) and region specific data are now available. During week 49, 6.0% of all deaths reported through the 122 Cities Mortality Reporting System were due to pneumonia and influenza (P&I). This percentage was below the epidemic threshold of 6.6% for week 49.

For the 2014–2015 influenza season, CDC/Influenza Division and the National Center for Health Statistics (NCHS) are collaborating on a pilot project to use NCHS mortality surveillance data for the rapid assessment of pneumonia and influenza (P&I) mortality.

Two influenza-associated pediatric deaths were reported to CDC during week 49. One death was associated with an influenza A (H3) virus, and one was associated an influenza A virus for which no subtyping was performed. Both deaths occurred during week 48 (week ending November 29, 2014). To date, seven influenza-associated pediatric deaths have been reported for the 2014–2015 season.

Between October 1, 2014 and December 6, 2014, 1,028 laboratory-confirmed influenza-associated hospitalizations were reported. The overall hospitalization rate was 3.8 per 100,000 population. The highest rate of hospitalization was among adults aged ≥65 years (13.4 per 100,000 population), followed by children aged 0-4 years (6.2 per 100,000 population). Among all hospitalizations, 952 (92.6%) were associated with influenza A, 68 (6.6%) with influenza B, 4 (0.4%) with influenza A and B co-infection, and 4 (0.4%) had no virus type information. Among those with influenza A subtype information, 274 (100%) were H3N2 virus. Additional virus characterization is available on FluView.

Nationwide during week 49, 2.5% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is above the national baseline of 2.0%. ILI is defined as fever (temperature of 100°F [37.8°C] or greater) and cough and/or sore throat. An Influenza Summary Update of the influenza activity reported by state and territorial epidemiologists, which indicates geographic spread of influenza viruses but does not measure the intensity of influenza activity, is available. This currently reflects data from December 6, 2014. At this time, 6 states and Puerto Rice are reporting widespread influenza activity.

The FluView report for week 49 and archives of previous FluViews are available from CDC. CDC also has released seasonal influenza key points for December 12, 2014.

CDC Spotlight Article on Influenza

Please take a look at the CDC’s Spotlight article on influenza and influenza coverage. This was developed as part of the National Influenza Vaccination Week, which just ended on December 12, 2014. An infographic on the benefits of flu vaccination also was released.

Updated Key Points on EV-D68 infections and disease

The United States has been experiencing a nationwide outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness. Updated EV-D68 key points, current as of December 11, 2014, include the weekly update of EV-D68-like illness activity in states and specimens that tested positive for EV-D68 from patients who died.

Updated Information on Acute Flaccid Myelitis

Up-to-date key points from December 11, 2014 are now available about the investigation of acute flaccid myelitis in children, including the weekly update of CDC-verified neurologic illness cases reported by states that meet the case definition.

Interim 2014-2015 Influenza Season Vaccination Coverage Rates

CDC has reported early season influenza vaccination coverages estimates for 2014–2015. Key points and an additional story related to these estimates are available.

Briefly, CDC notes that despite the benefits of flu vaccination, fewer than half of the people in the U.S. had reported getting a flu vaccine this season as of early November 2014. National early-season vaccination coverage estimates indicate that 40% of Americans 6 months and older had received a flu vaccination by early November 2014 (40% of adults and 42% of children). This is similar to flu vaccination coverage last season at the same time. Other online coverage reports indicated that vaccination among pregnant women (44%) and health care providers (64%) is about the same as it was this time last year. Among health care providers, the agency again noted high vaccination rates among pharmacists (87%), nurse practitioners/physician assistants (86%), physicians (82%), nurses (81%), and other clinical professionals (72%). Flu vaccination was lowest among assistants or aides (47%) and administrative/non-clinical support staff (59%).

Hospitalizations Prevented by Influenza Vaccination in Latest MMWR

The December 12, 2014 Morbidity and Mortality Weekly Report (MMWR) contains the report Estimated Influenza Illnesses and Hospitalizations Averted by Vaccination – United States, 2013–14 Influenza Season. Key points for this MMWR also have been released by CDC’s Influenza Division.

Briefly, the article:

Highlights that flu vaccination last season prevented an estimated 7.2 million flu-associated illnesses and 90,000 flu hospitalizations;

Underscores the severity of flu – estimating that there were 35.4 million influenza-associated illnesses, 14.6 medically attended flu illnesses, and 314,000 flu hospitalizations in the United States last season; and

Indicates that the 2013–2014 flu season was characterized as “moderately severe,” with the H1N1 pandemic virus predominating in the United States for the first time since the pandemic.

The report also notes that if vaccination rates were substantially improved (to 70 percent, for example), another 5.9 million flu illnesses, 2.3 million medically attended illnesses, and 42,000 flu hospitalizations could have been prevented.

CDC Media Briefing on Influenza

CDC held a telebriefing on December 4, 2014 to discuss the current flu season, noting that influenza A (H3N2) flu viruses are predominant so far. H3N2-predominant seasons are often associated with more hospitalizations and deaths, especially in young children and older people. CDC also highlighted laboratory information indicating that about half of analyzed H3N2 viruses this season are different from the H3N2 vaccine virus, a factor which may reduce how well the vaccine protects against those drifted H3N2 viruses. Despite the detection of drifted viruses, CDC continues to recommend flu vaccination as the best way to prevent the flu. While it’s not possible to know what viruses will circulate over the course of the flu season, the vaccine protects against three or four different viruses. Also, it’s possible that vaccination may still provide some protection against the drifted viruses, lessening severe flu-associated outcomes like hospitalization and death.

While vaccination is still the first and best way to prevent flu, CDC also recommends the use of influenza antiviral drugs as a second tool to fight flu and the complications it causes. Antiviral medications are not a substitute for vaccination (which prevents flu), but they are an important second line of defense to treat flu illness. Treatment with antiviral drugs is especially important for people at high risk of serious flu complications or people who are very sick with flu.

Upcoming and Recent CDC COCA Calls

EMS and Ebola: Field Experience with Transporting Patients

Date: Monday, December 15, 2014
Time: 2:00 – 3:00 pm (EDT)
Dial In Number: 888-972-6898 (U.S. Callers); 630-395-0194 (International Callers)
Passcode: 5076538

Healthcare systems across the United States are actively preparing to treat patients with Ebola. Emergency Medical Services (EMS) play an important role in the identification, assessment, and transportation of suspected or confirmed patients with Ebola. As designated treatment facilities, Emory University Hospital and the University of Nebraska Medical Center have received patients with confirmed Ebola. During this COCA Call, clinicians will learn about the field experiences of EMS personnel in the two jurisdictions and discuss unique planning considerations for EMS.

Caring for Patients with Ebola in U.S. Hospitals: A Nursing Perspective
Date: Monday, November 24, 2014.
Archived at: emergency.cdc.gov/coca/calls/2014/callinfo_112414.asp

ANNOUNCEMENTS

FDA approves FluZone® Intradermal quadrivalent

The U.S. Food and Drug Administration approved the supplemental biologics license application for Fluzone Intradermal Quadrivalent vaccine on December 12, 2014. Fluzone Intradermal vaccine, which has been available in trivalent formulation for three years, is now available in a quadrivalent formulation to help protect against four strains of influenza virus. A press release on this approval was published by Sanofi Pasteur.

FDA approves Gardasil® 9-valent

The U.S. Food and Drug Administration (FDA) announced the approval of Gardasil 9 (human papillomavirus [HPV] 9-valent vaccine, recombinant) on December 10, 2014. The vaccine is intended for the prevention of certain cancers and diseases caused by nine HPV types (types 6, 11, 16, 18, 31, 33, 45, 52, and 58). A press release on this approval was published by Merck.

Scientists Find Gene They Say Affects Flu Shot Response

Researchers say they’ve pinpointed a gene that affects how much protection the flu vaccine gives a person. gene that affects how much protection the flu vaccine gives a person. They analyzed blood samples from more than 200 people who’d had organ transplants. The researchers found that versions of a gene called IL-28B influenced the strength of the immune response triggered by the flu vaccine. Additional details are available in the scientific publication.

NAICP Strategies for Health Departments to Increase Adult Immunization

Karen Donoghue (NH), Co-Chair of the National Adult Immunization Coordinators’ Partnership (NAICP) presented the NAICP Strategies for Health Departments to Increase Adult Immunization during the Association of Immunization Managers (AIM) General Membership Call held on December 11, 2014. The document is based on recommendations from the NVAC Standards for Adult Immunization Practice for public health entities like state and local health departments. The Strategies document contains a variety of activities and strategies that state and local health departments can implement to help increase adult immunization rates. The document is focused on determining community needs, addressing barriers to immunization, outreach to providers, and the public and partnerships with key stakeholders. It also contains a sidebar highlighting 4 low-cost strategies that can be implemented quickly and easily.

Attend the NFID’s Spring Clinical Vaccinology Course

Based on the need to increase immunization efforts as well as the need for effective communication strategies, NFID invites Summit partners to attend the Spring 2015 Clinical Vaccinology Course (CVC) scheduled for March 13–15, 2015 in Denver, CO. The agenda includes presentations on the latest Advisory Committee on Immunization Practices (ACIP) recommendations and strategies to increase immunization rates in practice.

Attendees will leave the course with:

Skills to communicate effectively with patients and parents about vaccine concerns
Resources to educate patients and colleagues
Knowledge to administer vaccines appropriately
Best practices to improve childhood, adolescent, and adult immunization rates

Registration information is available online.

PBS NewsHour Features Story on Influenza: What you need to know about this year’s elevated flu threat

‘Tis the season to be sick, and this year’s flu shot may not save you. Doctors are warning that the season could be more severe than they thought because a strain of the virus is not responding to the vaccine. Gwen Ifill gets tips for how to prepare from L.J. Tan of the Immunization Action Coalition. The full news story that aired on December 11, 2014, is available for viewing.

USA Today and MediaPlanet Launch “The Fight Against The Flu” Campaign

Through USA Today, targeted distribution and endless online/social media outlets, this publication, both in print and digitally, will reach around 3 million readers. To help raise awareness of the cause, please feel free to share the campaign with your followers and audience by posting a link to the campaign on your company blog, website, or newsletter, as well as across your social media platforms.

National Hockey League (NHL) Experiences Mumps Outbreak

The NHL is dealing with a widespread outbreak of the virus, with players from Anaheim, Minnesota, the New York Rangers, and the New Jersey Devils among those affected.

As shown below, multiple news reports have been published about the outbreak, and some pretty big name stars are impacted.

Mumps Outbreak Puzzles NHL (ABC News)

NHL’s Mumps Outbreak Hits League’s Best Player (New York Post)

Like Sidney Crosby, Rangers’ Derick Brassard Contracts the Mumps (New York Daily News/blog)

Derick Brassard Sent Home from Rangers Road Trip, Mumps Suspected (CBSSports.com)

The NHL’s Mumps Epidemic Hits Rangers Again (New York Post)

NHLers May be Battling Mumps, but Most British Columbians Have Little to Fear: Signed, Vaccines (The Province)

Penguins Star Sidney Crosby Diagnosed with Mumps (CBSSports.com)

Sidney Crosby Diagnosed with the Mumps (USA Today)

Penguins’ Sidney Crosby Has Mumps (ESPN)

Sidney Crosby the Latest NHL Player Diagnosed with the Mumps (CTV News)

CDC and FDA Revising VAERS Form – Seeking Public Input Until January 23, 2015

As announced in the Federal Register, the US Centers for Disease Control and Prevention (CDC) and US Food and Drug Administration (FDA) are calling for comments on a new adverse event reporting form for vaccines meant to replace the current paper-based reporting form.

Every Child By Two (ECBT) Compiles Media Information on Its Website

On a daily basis, ECBT assembles significant news media coverage on immunizations in their “Daily Clips.” Summit partners may find this effort useful.

Summit Website Offers Wonderful Resources on Influenza Vaccination!

Remember to visit the Summit website for the latest on influenza immunization resources! You can also find archived copies of the Summit Buzz there.

Reminder

Summit calls are scheduled every Thursday at 3 pm ET, unless cancelled. Please email L.J Tan or LaDora Woods if you have any updates on activities to provide to the Summit.